Which healthcare agencies are affected by the government shutdown?

The government shutdown that started Oct. 1, drastically affects healthcare services provided by the U.S. government. The Department of Health and Human Services (HHS) houses several agencies dealing with the nation's most vulnerable populations. Based on the department's 2014 staffing and operation plan, 40,512 people, or 52% of the HHS staff, is being furloughed due to the government shutdown.

Below is a portion of the HHS contigency plan that details which agencies and services are being haulted by the government shutdown. The complete document can be viewed on the HHS Web site.

Summary of Activities to Remain Open and to be Closed

Consistent with legal advice that activities authorized by law, including those that do not rely on annual appropriations, and activities that involve the safety of human life and protection of property are to be continued, some of the HHS activities that would continue include:

• Indian Health Service (IHS) – IHS would continue to provide direct clinical health care services as well as referrals for contracted services that cannot be provided through IHS clinics.

• Health Resources and Services Administration (HRSA) – HRSA would continue activities funded through sources other than annual appropriations including the Community Health Centers, National Health Service Corps, Maternal Infant, and Child Health Home Visiting program. Additionally, HRSA would continue the National Practitioner Databanks and Hansen’s Disease Program.

• Administration for Children and Families (ACF) – ACF would continue mandatory funded programs including the Federal Parent Locator Service, Personal Responsibility Education, and Health Profession Opportunity Grants. Child support and foster care services will also continue because they receive advanced appropriations in the FY 2013 appropriation process. All permissible activities for the Unaccompanied Alien Children program under an exception of preserving human life will continue.

• Administration for Community Living (ACL) – ACL would continue to support the Aging and Disability Resource Centers and Health Care Fraud and Abuse Control through mandatory appropriations.

• Substance Abuse and Mental Health Services Administration (SAMHSA) – SAMHSA would continue programs such as the Disaster Distress Helpline, Treatment Locator, Treatment Referral Line, and Suicide Prevention Lifeline using available grant balances.

• Assistant Secretary for Preparedness and Response (ASPR) – ASPR would continue to maintain minimal readiness and limited staffing for all-hazards preparedness and response operations including the Secretary’s Operations Center, the National Disaster Medical System, and specialized medical countermeasure response under the safety of human life exception.

• National Institutes of Health (NIH) – NIH would continue patient care for current NIH Clinical Center patients, minimal support for ongoing protocols, animal care services to protect the health of NIH animals, and minimal staff to safeguard NIH facilities and infrastructure.

• Centers for Disease Control and Prevention (CDC) – CDC will continue minimal support to protect the health and well-being of US citizens here and abroad through a significantly reduced capacity to respond to outbreak investigations, processing of laboratory samples, and maintaining the agency’s 24/7 emergency operations center. CDC would also continue activities supported through mandatory funding including the World Trade Center health program, U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC’s Global AIDS program, the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), Vaccines for Children (VFC) program, and certain childhood obesity activities and asbestos exposure in Libby, Montana.

• Agency for Healthcare Research and Quality (AHRQ) – AHRQ would continue to maintain oversight of ongoing projects funded by the Patient-Centered Outcomes Research Trust Fund (PCORTF) and would continue CMS-funded work related to measure development for the Children's Health Insurance Program Reauthorization Act.

• Food and Drug Administration (FDA) – FDA would continue limited activities related to its user fee funded programs including the activities in the Center for Tobacco Products. FDA would also continue select vital activities including maintaining critical consumer protection to handle emergencies, high-risk recalls, civil and criminal investigations, import entry review, and other critical public health issues.

• Centers for Medicare & Medicaid Services (CMS) – CMS would continue large portions of ACA activities, including coordination between Medicaid and the Marketplace, as well as insurance rate reviews, and assessment of a portion of insurance premiums that are used on medical services. In the short term, the Medicare Program will continue largely

without disruption during a lapse in appropriations. Additionally, other non- discretionary activities including Health Care Fraud and Abuse Control, Center for Medicare & Medicaid Innovation, and Pre-existing Condition Insurance Plan activities would continue. States will have funding for Medicaid on October 1, due to the advanced appropriation enacted in the FY 2013 appropriations legislation, as well as for the Children’s Health Insurance Program (CHIP).

Activities that would not continue include:

• IHS – IHS would be unable to provide funding to Tribes and Urban Indian health programs, and would not perform national policy development and issuance, oversight, and other functions, except those necessary to meet the immediate needs of the patients, medical staff, and medical facilities.

• HRSA – HRSA would be unable make payments for the Children’s Hospital GME Program and Vaccine Injury Compensation Claims. Monitoring of Ryan White Grants – particularly AIDS Drug Assistance Program Grants, Emergency Relief Grants and Comprehensive Care would be insufficient to assure states, cities and communities are complying with statutory guidance and necessary performance.

• ACF – ACF would not continue quarterly formula grants for Temporary Assistance for Needy Families, Child Care, Social Services Block Grant, Refugee Programs, Child Welfare Services and the Community Service Block Grant programs. Additionally new discretionary grants, including Head Start and social services programs, would not be made.

• ACL – ACL would not be able to fund the Senior Nutrition programs, Native American Nutrition and Supportive Services, Prevention of Elder Abuse and Neglect, the Long- Term Care Ombudsman program, and Protection and Advocacy for persons with developmental disabilities.

• NIH – NIH would not admit new patients (unless deemed medically necessary by the NIH Director), or initiate new protocols, and would discontinue some veterinary services. NIH will not take any actions on grant applications or awards.

• CDC – CDC would be unable to support the annual seasonal influenza program, outbreak detection and linking across state boundaries using genetic and molecular analysis, continuous updating of disease treatment and prevention recommendations (e.g., HIV, TB, STDs, hepatitis), and technical assistance, analysis, and support to state and local partners for infectious disease surveillance.

• AHRQ – AHRQ would be unable to fund new grants and contracts related to health services research initiatives, including research on improving patient safety and reducing healthcare-associated infections. In addition, the data collection and modifications to the household survey of the Medical Expenditure Panel Survey would be stopped.

• SAMHSA – SAMHSA would be unable to monitor grants or contracts, including activities requiring on-site supervision.

• CMS – CMS would be unable to continue discretionary funding for health care fraud and abuse strike force teams resulting in the cessation of their operations. Fewer recertification and initial surveys for Medicare and Medicaid providers would be completed, putting beneficiaries at risk of quality of care deficiencies.

• FDA - FDA will be unable to support the majority of its food safety, nutrition, and cosmetics activities. FDA will also have to cease safety activities such as routine establishment inspections, some compliance and enforcement activities, monitoring of imports, notification programs (e.g., food contact substances, infant formula), and the majority of the laboratory research necessary to inform public health decision-making.

• ASPR - ASPR would be unable to fund activities related to medical countermeasures against chemical, biological, radiological, nuclear, and emerging threats, the Hospital Preparedness Program, and fully staff the National Disaster Medical
  System. Additionally, the potential assistance to Colorado in recovering from recent unprecedented flooding and the preparation to respond to H7N9 influenza or MERS incident could be delayed.

• ONC - ONC will be unable to continue the Standards and Interoperability Framework activities as well as related standards and testing activities; policy activities such as privacy, security, and clinical quality measure development; and administration of the Certified Health IT Product List.